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Diamond et al. Plast Aesthet Res 2019;6:20 Plastic and
DOI: 10.20517/2347-9264.2019.26 Aesthetic Research

Original Article Open Access

Limb preservation with suprafascial and thin
perforator flaps: salvaging osteomyelitis, Charcot

collapse and critical limb ischemia

Shawn Diamond , Andres F. Doval , Benjamin Scott , Matthew L. Iorio 2
1
1
1
1 Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
2 Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CO 80045, USA.

Correspondence to: Dr. Matthew L. Iorio, Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical
Center, 12631 E. 17th Ave, C309 (Room 6414), Aurora, CO 80045, USA. E-mail: matt.iorio@ucdenver.edu

How to cite this article: Diamond S, Doval AF, Scott B, Iorio ML. Limb preservation with suprafascial and thin perforator flaps: salvaging
osteomyelitis, Charcot collapse and critical limb ischemia. Plast Aesthet Res 2019;6:20. http://dx.doi.org/10.20517/2347-9264.2019.26
Received: 3 Jun 2019 First Decision: 11 Jul 2019 Revised: 17 Jul 2019 Accepted: 20 Jul 2019 Published: 12 Aug 2019

Science Editor: Raúl González-García Copy Editor: Cai-Hong Wang Production Editor: Tian Zhang

Abstract

Aim: There are limited reports in the United States demonstrating outcomes of primarily thinned fasciocutaneous flaps
in the setting of critical limb ischemia, Charcot collapse and osteomyelitis. We hope to determine patient and flap related
outcomes in advanced lower extremity disease.

Methods: The authors conducted a retrospective review of fasciocutaneous free flaps of variable thickness for lower
extremity salvage. Osteomyelitis and non-osteomyelitis patients were compared according to our primary outcome
measures: functional ambulation, bone healing and complications to flap and patient. Subgroups with critical limb
ischemia, Charcot collapse and diabetic foot were analyzed separately.

Results: Fifty-nine patients underwent free flap reconstruction: osteomyelitis (n = 20, 34%), Charcot collapse (n = 22,
37%), and/or critical limb ischemia (n = 12, 20%). All patients underwent anterolateral thigh flaps tailored for defect-
specific thicknesses: 17 superthin, 25 suprafascial, 17 subfascial. There were no significant differences between groups
in terms of partial and complete flap loss (P = 1.000 and P = 0.108). Ninety-one percent of patients were ambulatory
at follow up. Eighty-five percent of individuals with osteomyelitis cleared their infection demonstrating radiographic
bone healing. Two patients developed recalcitrant deep space infections ultimately requiring amputation. Subgroup
analysis did not show any differences in flap related complications within the diabetic Charcot population. In multivariate
regression, preoperative revascularization was independently associated with failure of limb salvage.

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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